Modular patient positioning system

ABSTRACT

During orthopedic surgeries, body parts are moved in different ways to cause different anatomic features (e.g. muscles or the trochanters) to tighten or loosen, or become more or less prominent during the intended surgical incisions, which can result in easier surgical procedures. Body parts can be moved using a variety of different structures. The exemplary structures described herein can allow for: (1) a person&#39;s leg and foot to be rotated about the axis of the leg (i.e., femur/tibia axis); (2) a person&#39;s leg can be pivoted generally about the hip/femoral head/acetabulum to vary the angle between the axis of the leg and a median sagittal plane; (3) a person&#39;s leg can be moved in a direction parallel to the leg axis; and/or a person&#39;s leg can be pivoted in a generally vertical plane, about the femoral head/acetabulum while the axis of the leg and the median sagittal plane remaining substantially parallel.

RELATED APPLICATIONS

This application claims priority to co-pending U.S. patent applicationSer. No. 15/015,109, filed Feb. 3, 2016, the contents of which areincorporated herein by reference in its entirety.

FIELD OF DISCLOSURE

The disclosure is generally directed to the field of modular patientpositioning systems (referred to herein as “MPPS”). In particular, thedisclosure is directed to the field of MPPSs for use in orthopedicsurgery and conveniently positioning or extending different bodyportions to be operated upon in different positions. The system of thecurrent disclosure allows surgeons and operating room staff to use areduced amount of hardware in combination with a foundational device toposition, support, and improve the results of the surgical procedure.Moreover, small movements that can cause joint misalignment arepreventable with the system. The modularity of the system also allowsone system to be used for posterior or anterior hip surgery, kneesurgery, extremity surgery, as well as a sit-up position for neck orshoulder surgery. The system also allows for controlling the anatomicpositions, such as flexion/extension, abduction and adduction,elevation/depression, rotation and distraction/compression of variousjoints or bones, such as the hip or knee.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A shows a first exemplary embodiment of an MPPS, which comprisestwo separate pegboards and in a first configuration. FIG. 1B showsanother exemplary embodiment of an MPPS that comprises one pegboard.

FIG. 2 shows the first exemplary embodiment of the MPPS of FIG. 1A in asecond configuration.

FIG. 3A, FIG. 3B, FIG. 3C show various exemplary ways that the MPPS ofFIG. 1A may be used during surgery.

FIG. 4 shows how when the MPPS of FIG. 1A is in the secondconfiguration, the patient's upper body is in a raised position thatmakes surgery on the upper portion of the patient's upper body easier.

FIG. 5A and FIG. 5B show other exemplary embodiments of an MPPS; inthese exemplary embodiments, pegs are shown for retaining a portion of apatient's body in an operating position. The embodiment of FIG. 5A iswider than the embodiment of FIG. 5B.

FIG. 6 shows another embodiment of the MPPS; in this exemplaryembodiment, the MPPS is for supporting a first part of the patient'supper body and providing unobstructed access to a second part of thepatient's upper body, on which surgery is to be performed.

FIG. 7A, FIG. 7B are rear views, showing how the exemplary embodiment ofFIG. 6 allows unobstructed access to either of the left or right sideparts of the patient's upper body, on which surgery is to be performed.

FIG. 8 shows another exemplary embodiment of the MPPS; in this exemplaryembodiment, an arm pegboard extends outwardly beyond side edges of asecond pegboard and a surgical table.

FIG. 9A, FIG. 9B, FIG. 9C show different exemplary ways in whichadditional pegboards, such as the arm pegboards of FIG. 8, may beconnected to the rest of the MPPS.

FIG. 10A and FIG. 10B show examples of performing arm surgeries with theexemplary embodiments of FIG. 2 and FIG. 8 respectively.

FIG. 11A, FIG. 11B, FIG. 11C show additional exemplary embodiments ofthe MPPS; in these exemplary embodiments, the MPPS includes an x-rayfacilitating cut-out.

FIG. 12A, FIG. 12B, and FIG. 12C show another exemplary embodiment ofthe MPPS; in this exemplary embodiment, a generic positioning member forretaining a portion of the patient's body that is to be operated on in adesired surgical position using pegs as a supporting/holding mechanismis included.

FIG. 13 shows the exemplary generic positioning member of FIGS. 12A,12B, and 12C, in use to position a patient's body in a laterally uprightconfiguration.

FIG. 14A-14C, show other exemplary embodiments of an MPPS, theseexemplary embodiments including various positioning members for use onsurgery on different specific body parts.

FIG. 15A and FIG. 15B show an exemplary embodiment of an MPPS forfacilitating surgery on a patient's neck and/or shoulder area.

FIG. 16A and FIG. 16B show additional exemplary embodiment of an MPPS.

FIG. 17 shows the exemplary embodiment of the MPPS of FIG. 16 in aconfiguration for surgery on a portion of a patient's lower body andpositioned on a surgical table, similar to FIG. 3A, FIG. 3B, and FIG.3C.

FIG. 18A, FIG. 18B, FIG. 18C, FIG. 18D, FIG. 18E show the exemplaryembodiment of the MPPS of FIG. 16 in positions for conducting surgery onone of a patient's legs (FIG. 18A), a patient's knee (FIG. 18B), and/orboth of a patient's legs (FIG. 18C). FIG. 18D shows the use of a legpositioner for flexing, e.g., a knee, during surgery thereon. FIG. 18Eshows peg-using structures for use with a leg positioner to vary theposition of the leg positioner and thereby adjust the amount offlexion/extension and/or distraction/compression of at least a portionof the leg.

FIG. 18F and FIG. 18G show a different structure of a leg positionerthat can be used to achieve one or more of various anatomicalpositionings.

FIG. 18H shows yet another exemplary embodiment for adjusting the amountof flexion/extension and/or distraction/compression of at least aportion of the leg based upon the position of the leg positionerrelative to the end of a pegboard.

FIG. 18I shows an alternative exemplary embodiment of FIG. 18H.

FIG. 18J shows an alternative embodiment of a leg positioner that allowsfor adjusting the amount of axial rotation of a leg/hip/knee during anorthopedic surgery.

FIG. 18K and FIG. 18L and FIG. 18M show how the axial rotation of theleg can be varied using the alternative leg positioner of FIG. 18J.

FIG. 18N shows an alternative means by which the position of a legduring surgery can be adjusted.

FIG. 19A, FIG. 19B, and FIG. 19C, show the exemplary embodiments ofFIGS. 18A, 18B, and 18C, respectively in side views.

FIG. 20 shows the exemplary embodiment of the MPPS of FIG. 16A in aconfiguration for performing surgery on an upper portion of a patient'sbody.

FIG. 21A and FIG. 21B are rear views similar to those of FIG. 7A andFIG. 7B, respectively, where different portions of the patient's upperbody are supported and different portions of the patient's upper bodyare unobstructed for surgery thereon.

FIG. 22 is a rear view, similar to the rear views of FIG. 21A and FIG.21B, but showing where the MPPS is configured to support substantiallythe entire upper body.

FIG. 23 shows a person, the median sagittal plane of that person, andthe various exemplary anatomical directions in which a leg to beoperated on can be moved.

FIG. 24A shows at least one of axial rotation, abduction/adduction,elevation/depression, distraction/compression or flexion/extension of atleast a portion of the leg being adjusted.

FIG. 24B shows at least two of axial rotation, abduction/adduction,elevation/depression, distraction/compression or flexion/extension of atleast a portion of the leg being adjusted.

FIG. 24C shows at least three of axial rotation, abduction/adduction,elevation/depression, distraction/compression or flexion/extension of atleast a portion of the leg being adjusted.

FIG. 24D shows all of axial rotation, abduction/adduction,elevation/depression, distraction/compression or flexion/extension of atleast a portion of the leg being adjusted.

FIG. 25A shows a common leg/knee positioning used during an orthopedicsurgery.

FIG. 25B shows how, by using the exemplary leg positioners describedherein, the positioning of FIG. 25A can be achieved and in a more securemanner.

FIG. 26 shows a pivot system that can be used with the adjustablepegboard systems described herein for use in controlling the amount ofabduction/adduction.

FIG. 27 shows how the pivot system of FIG. 26 is set up.

FIGS. 28A and 28B show a first exemplary way of how the pivot system ofFIGS. 26, 27 can be used, respectively.

FIGS. 29A and 29B show a second exemplary way of how the pivot system ofFIGS. 26, 27 can be used, respectively.

FIGS. 30A, 30B, 30C, and 30D depict an alternative exemplary embodimentfor a mounting structure that allows for varying the position orelevation of the knee.

DETAILED DESCRIPTION

It will be appreciated that for simplicity and clarity of illustration,numerous specific details are set forth in order to provide a thoroughunderstanding of the embodiments described herein. However, it will beunderstood by those of ordinary skill in the art that the embodimentsdescribed herein can be practiced without these specific details. Inother instances, methods, procedures and components have not beendescribed in detail so as not to obscure the related relevant featurebeing described. Also, the description is not to be considered aslimiting the scope of the embodiments described herein. The drawings arenot necessarily to scale and the proportions of certain parts have beenexaggerated to better illustrate details and features of the presentdisclosure. Similar reference numerals are used to refer to structuressimilar to the various exemplary embodiments.

The embodiments shown and described above are only examples. Therefore,many such details are neither shown nor described. Even though numerouscharacteristics and advantages of the present technology have been setforth in the foregoing description, together with details of thestructure and function of the present disclosure, the disclosure isillustrative only, and changes may be made in the detail, especially indecorative and structural matters of shape, size and arrangement of theparts within the principles of the present disclosure up to, andincluding the full extent established by the broad general meaning ofthe terms used in the claims. It will therefore be appreciated that theembodiments described above may be modified within the scope of theclaims.

During orthopedic surgeries, it can be useful to move different bodyparts in different ways to cause different anatomic features (e.g.muscles or the trochanters) to, for example: tighten or loosen, becomemore or less prominent, or “move out of the way” of intended surgicalincisions. Body parts can be moved in a variety of ways to achievedifferent anatomical positionings. Common exemplary terms used todescribe anatomical movements include: flexion/extension, abduction andadduction, elevation/depression, rotation, and distraction/compression.

Some various ways in which body parts can be moved will be describedwith reference to FIG. 23, which shows a person and the median sagittalplane of that person, and FIGS. 24A-D.

As shown by arrow A-A of FIG. 23, a person's leg and thus also theperson's foot, can be rotated about the axis of the leg (i.e.,femur/tibia axis). As used herein, this type of movement will be calledaxial rotation.

As shown by arrow B-B of FIG. 23, a person's leg can be pivotedgenerally about the hip/femoral head/acetabulum), to vary the anglebetween the axis of the leg (i.e., femur/tibia axis) and the mediansagittal plane, resulting in potentially easier surgical procedures. Asused herein, this type of movement will be called abduction/adduction.

As shown by arrow C-C of FIG. 23, a person's foot/lower leg (tibia) canbe moved in a direction parallel to the leg axis (femur/tibia axis)towards or away from the body trunk. During this type of movement,several other movements may occur, depending up how or whether differentbody parts are constrained. For example, there can be kneeflexion/extension; hip flexion/extension, knee distraction/compression,or knee distraction/compression. When allowing these types of movements,the angle of the femoral head within the acetabulum will change,resulting in potentially easier surgical procedures. As used herein,this type of movement will be called flexion/extension <?>.

As shown by arrow D-D of FIG. 23, a person's leg can be pivoted in agenerally vertical plane, about the femoral head/acetabulum axes whilethe axis of the leg (femur/tibia axis) and the median sagittal planeremaining substantially parallel, resulting in potentially easiersurgical procedures. As used herein, this type of movement will becalled elevation/depression.

Accordingly, by performing any of the movements described above, thepositioning of various anatomical hip features can be made more or lessprominent or moved out of the way of surgical incisions, as desired bythe surgical method to be used on that patient's hip and resulting inpotentially easier surgical procedures.

For example, in a first exemplary embodiment, at least one of axialrotation, abduction/adduction, elevation/depression,distraction/extraction or flexion/extension (see e.g. FIG. 24A) areadjusted.

In a second exemplary embodiment, at least two of axial rotation,abduction/adduction, elevation/depression, distraction/extraction orflexion/extension (see e.g. FIG. 24B) are adjusted.

In a third exemplary embodiment, at least three of axial rotation,abduction/adduction, elevation/depression, distraction/extraction orflexion/extension (see e.g. FIG. 24C) are adjusted.

In a fourth exemplary embodiment, all of axial rotation,abduction/adduction, elevation/depression, distraction/extraction orflexion/extension (see e.g. FIG. 24D) are adjusted.

As used herein, “of the leg” or “a portion of the leg” can comprises anyof anatomical features of the leg, including, but not limited to: foot,angle, tibia, fibular, knee, femur, hip and the anatomical features thecomprise the angle, knee, and hip joints.

The structure by which these various movements can be carried out aredescribed below.

FIG. 1A shows a first exemplary embodiment of a modular patientpositioning system (“MPPS”) 10 and in a first configuration. Thisexemplary embodiment of the MPPS 10 includes at least first pegboard 25and second pegboard 30. Typically, though not necessarily, the firstpegboard 25 and the second pegboard 30 are generally the same size. Thefirst pegboard 25 and the second pegboard 30 have pegboard holes 35therein, for reasons discussed below. The at least first pegboard 25 andsecond pegboard 30 may be connected together, such that the firstpegboard 25 and second pegboard 30 can be rotated relative to each otherbetween different configurations. In the exemplary embodiment of theMPPS of FIG. 1A; the first pegboard 25 and second pegboard 30 areconnected together by a hinge 50. Hinge 50 may comprise a removablehinge pin 51. However, as exemplified in FIG. 16B, hinges are notnecessary.

In a first configuration, as shown in FIG. 1A, the first pegboard 25 andsecond pegboard 30 lie along a common plane. In FIG. 1B, the MPPScomprises a single pegboard.

In a second configuration, as shown in FIG. 2, the first pegboard 25 andsecond pegboard 30 lie along different planes at an angle α. The secondconfiguration allows for different parts of a patient's body to bepositioned and supported in different planes. The second configurationusually includes one pegboard lying flat (e.g. substantiallyhorizontally) or parallel to a top surface of a surgical table and theother pegboard being at a positive or negative angle α relative to theflat pegboard (see discussions of FIGS. 3A-3C below). For ease ofreference and not intended to be limiting in any way, this disclosurewill refer to the “second pegboard” as the pegboard that is raised orlowered, as discussed further below.

FIGS. 3A-3C show various exemplary ways by which the second pegboard 30can be supported in a raised position relative to the first pegboard 25.

As shown in FIG. 3A, the MPPS 10 may be supported on (by) asurgical/operating table T (schematically shown). First pegboard 25 maybe clamped to a first, typically, fixed-positioned part T1 of thesurgical table T by a clamp C. The second pegboard 30 is supported inthe raised position by a rotatable portion T2 of the surgical table Tand may or may not be clamped to rotatable portion T2.

As shown in FIG. 3B, the MPPS 10 may be supported on (by) asurgical/operating table T (schematically shown). First pegboard 25 maybe clamped to a first, typically, fixed-positioned part T1 of thesurgical table T by a clamp C. The second pegboard 30 is moved into theraised position and supported in the raised position by a support memberS, such as a bar, frame, or wedge, between the top of the surgical tableand an underside of the second pegboard 30.

As shown in FIG. 3C, the MPPS 10 may be supported on (by) asurgical/operating table T (schematically shown). First pegboard 25 maybe clamped to a first, typically, fixed-positioned part T1 of thesurgical table T by a clamp C. The second pegboard 30 is moved into theraised position and supported in the raised position by hinge pin 51comprising a locking hinge pin.

The ability for the first pegboard 25 and second pegboard 30 to rotaterelative to each other and receive pads/cushions and pegs makes iteasier for a doctor to position different patient's in different bodypositions using pegs, pegboards, and pads to perform surgery on, forexample, upper portions U of a patient's body P. For example, as shownin FIG. 4, when the MPPS is in the second configuration: the firstpegboard 25 lies substantially flat on a surgical table T and the secondpegboard 30 is rotated upward and away from the plane of the firstpegboard 25. In this second configuration, the patient's lower body Llies generally flat on the first pegboard 25 substantially parallel withthe surgical table T and the patient's upper body U is supported at araised angle α above the plane of the first pegboard, to present thepatient's upper body U in a raised position that makes surgery on anupper portion U of the patient's upper body U easier.

Thus, when the part of the patient's upper body U to be operated oncomprises a shoulder, a doctor may use pads/cushions and pegs (seediscussion about FIGS. 5B, 5B, below) to specifically position differentpatient's in different body positions using pegs. This reduces doctorfatigue during the surgical procedure and maintains desired patientpositioning.

The angle α at which the second pegboard supports the patient's upperbody relative to the plane of the first pegboard can vary, but generallydepends on the heights of the surgical table and the doctor, so that thearea of the patient to be operated on is at a position where the surgeonneed not lean over the patient, stand in any awkward postures, etc.

As shown in FIG. 5A and FIG. 5B, one or more pegs 85 may be insertedinto pegboard holes 35 and protrude outwardly to retain a portion of thepatient's upper body U in a desired surgical position.

As shown in the exemplary embodiment of FIG. 1, the first pegboard 25and second pegboard 30 are generally identical in structure, allowingease of installation and replacement of broken parts. However, the firstpegboard 25 and second pegboard 30 need not be identical in structure.

For example, as shown in FIG. 6, the second pegboard 30 is L-shapedhaving a narrow portion 31 and a wide portion 32. Wide portion 32includes the hinge portion of second pegboard 30. The first pegboard 25is generally rectangular and equal in width to the wide portion 32 ofthe second pegboard 30. Thus, the hinge portion of wide portion 32 ofthe second pegboard 30 can be conveniently connected to the hingeportion of the first pegboard 25 by the hinge pin 51.

As shown in the rear views of FIG. 7A and FIG. 7B, the narrow portion 31of the second pegboard 30 supports a first part of the patient's upperbody U1 and provides unobstructed access to a second part of thepatient's upper body U2, on which surgery is to be performed. Forexample, as shown in rear view FIG. 7A, the patient's left shoulder issupported by narrow portion 31 of the second pegboard 30 and thepatient's right shoulder is unobstructed for surgery. As shown in rearview FIG. 7B, the second, L-shaped pegboard may be disconnected from thefirst pegboard, reversed in configuration, and then reconnected to thefirst pegboard, whereby the second, L-shaped pegboard may be positionedto provide unobstructed access to the left side of the patient's upperbody.

MPPS 10 can be used to raise or lower a patient's legs for surgerythereon, rather than the upper body by merely reversing the positioningof the first pegboard portion and the second pegboard portion. This isdescribed in more detail below. For example, as described below, raisingor lowering the second pegboard portion can be used to flex or relax apatient's knee or hip.

In another exemplary embodiment, as shown in FIG. 8, the MPPS 10 mayinclude additional pegboards for supporting various other body portions.For example, in FIG. 8 an arm pegboard 100 is shown that can beconnected to the second pegboard 30. In FIG. 8, the arm pegboard 100extends outwardly beyond side edges of the second pegboard 30 andsurgical table T, and may support an arm positioning member 200″ and apatient's arm for being operated on as shown in FIG. 10B. As shown inFIG. 10A, an arm positioning member 200′ that can be connected to thepegboard by pegs can support the patient's arm outwardly.

As shown in FIG. 9A, pegs 85 may be permanently affixed to the arm (orother additional) pegboard to be received in the pegboard holes 35 ofthe first pegboard 25 or second pegboard 30. As shown in FIG. 9B, pegs85 may be permanently affixed to the first pegboard 25 or secondpegboard 30 to be received in the pegboard holes 35 of the additionalpegboard 100. Yet further, as shown in FIG. 9C, the pegs 85 may beseparate elements that are received in the pegboard holes 35 of thefirst pegboard 25 or second pegboard 30 and pegboard holes 35 in theadditional pegboard 100.

As shown in FIG. 10A, when a first exemplary arm pegboard with a firstexemplary positioning member 200′ does not extend beyond the edges ofthe second pegboard 30 and the surgical table T, a patient's arm may besupported/stabilized in a first operating position while surgery on thesupported arm or opposite shoulder is performed. As shown in FIG. 10B,when a second exemplary arm pegboard with a second exemplary positioningmember 200″ extends beyond the edges of the second pegboard 30 and thesurgical table T, the patient's arm may be supported in a differentoperating position and/or flexed or relaxed. These multiple positionsallow for proper positioning and support on a patient's arm/wrist/handduring surgery thereon. For sake of convenience, as used in thedisclosure and claims “arm” shall be construed to be any body portionbelow the shoulder, including but not limited to, upper arm, elbow,lower arm, wrist, hand, or fingers. Similarly “leg” shall be construedto cover any body portion between the tips of the toes and thehip/pelvis.

Another feature that the MPPS may include is schematically shown inFIGS. 11A, 11B, 11C, wherein at least one of the pegboards 25, 30 has acut-out 125 therein. This cutout allows an x-ray film (or cassette) X tobe inserted into the area of the cut-out 125 for taking an unobstructedx-ray of the patient, i.e., without the blocking of the dense solidportions of the pegboard. As shown in FIG. 11B, a thin radiolucent cover130 may be positioned over the cut-out 125 for receiving the x-ray filmX thereunder while supporting the patient's body so there is no contactbetween the x-ray film X and the patient's skin. In FIG. 11C, the singlepegboard of FIG. 1B is provided with cutout 125.

Another feature that the MPPS may include is shown in FIG. 12A, FIG.12B, FIG. 12C. This feature includes a generic patient positioningmember 200 used to cover at least two pegs 85 being used to retain theportion of the patient's upper body that is to be operated on in adesired surgical position. Conventionally, in prior art methods, onepeg, in combination with tape, is used to position the pad and retain itin its proper position. As shown in FIG. 12A, FIG. 12B, FIG. 12C thepositioning member 200 comprises a positioning pad 201 (also known inthe art as cushion or pillow). The positioning pad 201 has an upperportion 202 and a lower portion 203; the upper portion 202 forcontacting a portion of the patient's body; and the lower portion 203having a plurality of blind holes 210 for receiving pegs 85.

The positioning member 200 can be used either in combination with anMPPS having a first pegboard 25 and second pegboard 30 or with aconventional full-sized pegboard (FIG. 1B). For example, as shown inFIG. 13, the MPPS may include at least one pegboard 25′ for positioningon a surgical table and supporting a portion of a patient. Positioningmember 200 aligns a portion of a patient's body in a surgical position.The positioning member has a plurality of holes 210 in a lower portionthereof. A plurality of pegs 85 are positioned in pegboard holes 35 atlocations where it is desired to position the positioning member 200.The positioning member 200 is then placed over the plurality of pegs 85,by the pegs 85 being received in the holes 210 in the lower portion ofthe positioning member 200. Conventionally, in prior art methods,positioning pads are fixed with tape to the table or pegboard to retainit in its proper position, or pads are wrapped around a single peg whenthe patient is fixed in a lateral position. FIG. 14A, FIG. 14B, and FIG.14C show other exemplary configurations for positioning member 200,useful with different and specific surgical procedures on various bodyparts.

FIG. 15A and FIG. 15B show an exemplary embodiment of an MPPS forfacilitating surgery on a patient's neck and/or shoulder areas. In thisexemplary embodiment, a first set of pegs 85 a are used to attachanother (e.g., neck) pegboard 105 to the upper portion/free end of thesecond pegboard 30. A second set of pegs 85 b protrude from the neckpegboard 105 on each side of the patient's neck. Finally, positioningmembers 200 are placed over pegs 85 b, as previously described. Thisconfiguration allows for a neck/shoulder positioning that is comfortableto both the doctor and patient.

FIG. 16A shows another exemplary embodiment of an MPPS. In FIG. 16A,MPPS 10′ is similar to the MPPS 10 of FIG. 1. The difference betweenMPPS 10′ and MPPS 10 is that MPPS 10′ has one of pegboards 25, 30,divided into two, separately rotatable pegboard parts, e.g., 30 a, 30 b.Furthermore, in FIG. 16B, pegboard part 30 b is not hinged to the restof the pegboard 25. In FIG. 16B, pegboard parts 30 b may be clamped tothe surgical table T in manners previously described. Typically,pegboard parts 30 a, 30 b will each have substantially the same width,and their combined width will be substantially equal to the width of theother pegboard, e.g., 25.

FIG. 17 shows the exemplary embodiment of the MPPS of FIG. 16A in aconfiguration for surgery on a portion of a patient's lower body andpositioned on a surgical table, similar to FIG. 3A, FIG. 3B, and FIG.3C. In FIG. 17, MPPS 10′ is supported on (by) a surgical table T(schematically shown). First pegboard 25 may be clamped to a first,typically fixed-position part T1 of the surgical table T by a clamp C.The second pegboard portions 30 a, 30 b, are supported in a raised orlowered position by a rotatable portion T2 of the surgical table T andmay or may not be clamped to rotatable portion T2.

FIG. 18A, FIG. 18B, FIG. 18C each schematically show the exemplaryembodiment of the MPPS 10′ of FIG. 16 in positions for conductingsurgery on one of a patient's legs (FIG. 18A), a patient's knee (FIG.18B), and/or both of a patient's legs (FIG. 18C). Note that thisfunctionality is useful because often, when a leg is being operated on,it may be angled in an up or down positioning to check rotation, providevisibility to all portions of the joint, and extend or relax muscles andligaments. For clarity, FIG. 19A, FIG. 19B, and FIG. 19C, show theexemplary embodiments of FIGS. 18A, 18B, and 18C, respectively in sideview.

In FIG. 18A, the patient's hip is generally aligned with the pivot axisbetween the first pegboard and the second pegboard. Therefore, pivotingof the pegboards cause either tensioning or extension (extend or relax)of the hip muscles. In FIG. 18B, the patient's knee is generally alignedwith the pivot axis between the first pegboard and the second pegboard.Therefore, pivoting of the pegboards cause either tensioning orextension (extend or relax) of the knee muscles. To further accuratelyposition a portion of a leg, such as a knee or hip during surgery, a legpositioner 300 may be used.

A first exemplary embodiment of a leg positioner is shown in FIG. 18Dand FIG. 18E. In this exemplary embodiment, peg holes located along aline oblique to the lateral or longitudinal axes of the pegboard mayhave a center to center distance of d1. Peg holes located along thelateral or longitudinal axis of the peg board may have center to centerdistances of d2. Typically, d2>d1. Leg positioner 300 includes a boot310 having a foot receiving portion 310 b for receiving the foot and legreceiving portion 310 a for receiving the lower portion of the leg whoseknee or hip is being operated on. Pegs 85 are attached to the boot 310so that the boot 310 can be fixed to pegboard 30 b in a desired positionthat provides the desired flexion/extension and/ordistraction/compression on the knee or hip, when pegboard 30 b isadjusted. While not necessary, a mounting block 90 may also be providedto ease the shearing forces on pegs 85. While not shown, it is possiblethat a surgical boot having a peg directly attached thereto can be usedto attach the foot to the pegboard to assist in flexing/extending and/ordistracting/compressing the knee or hip.

In FIG. 18E, mounting block 90 and its associated pegs are attached toleg receiving portion 310 a. In FIG. 18E, there are typically just oneset of pegs 85 protruding in a direction opposite to the foot receivingportion.

In FIG. 18F, block 90 and its associated pegs are attached to footreceiving portion 310 b. In FIG. 18F, there are typically multiple setsof pegs 85′ protruding at least in directions both perpendicular to thefoot receiving portion and parallel to the foot receiving portion(perpendicular to the leg receiving portion).

These two different ways in which pegs 85 are attached to boot 310result in different ways in which boot 310 may be mounted to thepegboard (see FIGS. 18K, 18L, and accompanying description.

FIG. 18F and FIG. 18G show a different structure of a leg positioner300′ and a mounting structure that can be used to achieve one or more ofthe various anatomical positionings described above.

In FIG. 18F and FIG. 18G, as with FIG. 18E, the amount offlexion/extension can be adjusted based upon the position of the legpositioner relative to the end of the pegboard. The further away fromthe end of pegboard that the pegs of the leg positioner are insertedinto the pegboard, the greater the flexion/extension and/ordistraction/compression of the knee or hip.

FIGS. 18H and 18I show other exemplary embodiments for adjusting theamount of flexion/extension based upon the position of the legpositioner relative to the end of the pegboard.

In FIG. 18H, leg positioner 300 is mounted to a slidable block 500,which forms part of the mounting structure and is slidably mounted to atrack 510 in the pegboard (the area in which the track is mounted neednot have pegboard holes).

Accordingly, in FIG. 18H, the position of 300 can be adjusted by varyingthe position relative to the end of pegboard at which slidable block 500is locked or clamped. The further away from the end of pegboard thatslidable block 500 is locked or clamped, the more flexion/extension ofthe knee and hip. The leg positioner 300 can be fixed to slidable block500 by pegs (FIG. 18H) or directly fixed to slidable block 500 (FIG.18I). In this exemplary embodiment, board 600 may have pegholes, nothave pegholes, or be omitted entirely, wherein the patient's upper bodylies directly upon the surgical table.

FIG. 18J shows an alternative embodiment of leg positioner 300′ thatallows for adjusting the amount of axial rotation of a leg/hip/kneeduring an orthopedic surgery. In FIG. 18J, the mounting structureincludes an optional mounting block 90′ located on foot receivingportion 310 b, such as it is in FIG. 18F, but different from as shown inFIG. 18E, where mounting block 90 is located on leg receiving portion310 a. Mounting block 90′ can have additional pegs 85′ and 85″protruding therefrom in a variety of directions. Preferably pegs 85′,85″ come in adjacent pairs for stability and rotation prevention. Thepair of pegs 85′ may have a center-to-center distance of d1. The pair ofpegs 85″ may also have a center-to-center distance of d1. The pair ofpegs 85 may have a center-to-center distance of d2. As previouslymentioned, d2>d1. These dimensions are used when corresponding to a pegboard, such as exemplified relative to FIG. 18D. If mounting block 90′is square or rectangular, pegs 85′ and pegs 85″ can protrude from thesides of the mounting block 90′. For increased flexibility of rotationamount, it is preferred that at least three sets of pegs can beprovided. Two sets of pegs 85′ are to be substantially perpendicular toeach other. The third set of pegs 85″ are to be oblique relative to theaxes of both the sets of pegs 85′. This oblique orientation may beachieved by mounting the pegs on an oblique wall 91′ of mounting block90′.

FIG. 18K and FIG. 18L and FIG. 18M show how the axial rotation of theleg can be varied using the alternative leg positioner 300′ of FIG. 18J.

In FIG. 18K, by positioning pegs 85′ that are parallel to the plane ofthe foot into the desired pegboard holes, the leg will be positionedwith no rotation and the foot substantially perpendicular to thepegboard.

In FIG. 18L, by positioning pegs 85′ that are perpendicular to the planeof the foot into the desired pegboard holes, the leg will be positionedwith 90 degrees of rotation and the foot substantially parallel to thepegboard.

In FIG. 18M, by positioning pegs 85″ that are oblique with the otherpegs 85′ into the desired pegboard holes, the foot and leg will bepositioned with an angle between 0-90 degrees of rotation (e.g. theoblique angle). The oblique wall 91′ of mounting block 90′ also providesadditional stability to the pegs 85″.

In FIG. 18N, by having the longitudinal axis of peg 85 be at an obliqueangle with block 90′, leg positioner 300 will be non-parallel to pegboard 30; thereby elevating the knee. Such a positioning can beadvantageous to surgery on the leg, etc.

FIG. 25A shows a common leg/knee positioning used during an orthopedicsurgery. The patient's leg is bent and the lower leg placed under thenon-bent leg. This causes flexion/extension and other movements, such asdistraction/compression in the bent leg, that make surgery thereoneasier.

FIG. 25B shows how, by using the exemplary leg positioners describedherein, the positioning of FIG. 25A can be achieved and in a more securemanner (by the boot being secure relative to the pegboard/table and thefoot being secure relative to the boot). Furthermore, strap S can beused to secure a knee in position, freeing up a nurse that typically isdedicated to holding the knee in place.

The leg positioner 300 and arm positioner 200′ (FIG. 10A) can beattached to the pegboards in substantially the same ways.

FIG. 20 shows the exemplary embodiment of the MPPS of FIG. 16 in aconfiguration for performing surgery on an upper portion of a patient'sbody. The details of this embodiment are generally the same as those ofFIG. 1, except for the fact that second pegboard 25 is formed by twosecond pegboards 30 a, 30 b.

FIG. 21A and FIG. 21B are rear views similar to those of FIG. 7A andFIG. 7B, respectively, where different portions of the patient's upperbody U2 are supported and different portions of the patient's upper bodyU1 are unobstructed for surgery thereon. Reference to FIG. 7A and FIG.7B will generally inform the reader of the features and functionality ofFIG. 21A and FIG. 21B.

FIG. 22 is a rear view, similar to the rear views of FIG. 21A and FIG.21B, but showing where MPPS 10′ is configured to support substantiallythe entire upper body U. Again, reference to FIG. 7A and FIG. 7B willgenerally inform the reader of the features and functionality of FIG.22.

FIG. 26 shows a mounting structure including a pivot system that can beused with, for example, the legs positioners 300, 300′ and adjustablepegboard systems described above for use in controlling the amount ofabduction/adduction. The pivot system includes a pivot support 500.Pivot support 500 comprises a main body 510. A pivot peg 520 protrudesin a first direction from a first side and first end of main body 510. Amounting bar 550 protrudes in a second direction, generally oppositefrom the first direction, from a second side and second end of main body510. A clamp (not shown) is used in combination with mounting bar 550 toattach pivot support 500 to a surgical table or pegboard. Typically,when in use, the first direction is upwards and the second direction isdownwards.

FIG. 27 shows how the pivot system is set up. In FIG. 27, a pegboard isprovided. Pivot peg 520 is received within a pegboard hole of thepegboard, generally at a corner of the pegboard, and at least partiallysupported by main body 510. During use, the patient's acetabulum will bepositioned generally close to (or overlaying) the pivot peg 520 suchthat pivoting the pegboard about the pivot peg pivots of the femurwithin the generally stationary acetabulum (see FIG. 24D). Additionally,as shown in FIGS. 29A, 29B, and 29C, mounting block 1000 can replacesupport block 90. Adjustable rotatable tension clamps 1010, 1020 can beused to vary the positioning or orientation of leg positioner 300.

FIGS. 28A, 28B and FIGS. 29A, 29B, show how the pivot system of FIGS.26, 27 is used. In FIGS. 28A and 29A, the leg pegboard is generallyparallel to the longitudinal axis of the main board 600 and thereforethe leg to be operated on will also be generally parallel to the axis ofthe main pegboard as well as the patient's median sagittal plane. Theleg to be operated will typically not lie in the plane of the main board600 (e.g. FIG. 17) because if it were to lie in the plane of the mainboard 600, it would not be possible for the pivoting pegboard to pivot,because the main board 600 or other leg pegboard would be anobstruction. Note that main board 600 may have pegholes, not havepegholes, or be omitted entirely, wherein the patient's upper body liesdirectly upon the surgical table.

In FIGS. 28B and 29B, the leg pegboard is pivoted about pivot peg 520 atsome desired angle relative to the axis of the main board 600 and thepatient's median sagittal plane. Therefore, the leg to be operated onwill also be at the desired angle relative to the axis of the main board600 and the patient's median sagittal plane. Accordingly, the amount ofrotation of the femur relative to the acetabulum can be adjusted,resulting in potentially easier surgical procedures. Note that mainboard 600 may have pegholes, not have pegholes, or be omitted entirely,wherein the patient's upper body lies directly upon the surgical table.

FIGS. 30A, 30B, 30C, and 30D depict an alternative exemplary embodimentfor a mounting structure that allows for varying the position orelevation of the knee. In this exemplary embodiment, positioner 1000with pegs receivable in peg board holes, receives a sphere 1100. Lever1200 applies or releases a locking grip on sphere 1100. Leg positioner300 is attached to sphere 1100 through mounting block 90′″. With thisexemplary embodiment, a wide range of motion (ROM) of leg positioner 300is available.

The exemplary embodiments shown and described above are only examples.Therefore, many such details are neither shown nor described. Eventhough numerous characteristics and advantages of the present technologyhave been set forth in the foregoing description, together with detailsof the structure and function of the present disclosure, the disclosureis illustrative only, and changes may be made in the detail, especiallyin decorative and structural matters of shape, size and arrangement ofthe parts within the principles of the present disclosure up to, andincluding the full extent established by the broad general meaning ofthe terms used in the claims. It will therefore be appreciated that theembodiments described above may be modified within the scope of theclaims.

That which is claimed:
 1. A modular patient positioning system,comprising: at least a first pegboard and a second pegboard, the firstpegboard and second pegboard can be rotated relative to each other;wherein: the first and second pegboards having at least one pegboardhole defined on at least one of the two pegboards; in a firstconfiguration, the first pegboard and second pegboard lie along a commonplane; and in a second configuration, the first pegboard and secondpegboard lie along different planes, whereby first and second parts of apatient's body may be positioned and supported in different planes byhaving the first pegboard support the patient's first body portion andthe second pegboard supports the patient's second body portion, whereinthe first body portion comprises an upper body portion and the secondbody portion comprises a leg receiving portion; and a leg positionerwith a mounting structure for mounting the leg positioner on the secondpegboard and positioning a leg in a predetermined position relative tothe second pegboard, the mounting structure of the leg positioner allowsfor adjusting at least one of axial rotation, abduction/adduction,elevation/depression, or flexion/extension of at least a portion of theleg.
 2. The modular patient positioning system of claim 1, wherein themounting structure of the leg positioner allows for adjusting at leasttwo of axial rotation, abduction/adduction, elevation/depression,distraction/compression, or flexion/extension a portion of the leg. 3.The modular patient positioning system of claim 1, wherein the mountingstructure of the leg positioner allows for adjusting at least three ofaxial rotation, abduction/adduction, elevation/depression,distraction/compression, or flexion/extension of at least a portion ofthe leg.
 4. The modular patient positioning system of claim 1, whereinthe mounting structure of the leg positioner allows for adjusting all ofaxial rotation, abduction/adduction, elevation/depression,distraction/compression, or flexion/extension of at least a portion ofthe leg.
 5. The modular patient positioning system of claim 1, wherein:the leg positioner including a boot, the boot having: a foot receivingportion receiving a foot of a leg whose knee or hip is being operatedon; a leg receiving portion receiving lower portion of a leg whose kneeor hip is being operated on; and a plurality of pegs mounted to the bootand for being received in the pegboard holes of the second pegboard tomaintain the leg positioner in a desired position.
 6. The modularpatient positioning system of claim 5, wherein the are multiplepluralities of pegs mounted to the boot and for being received in thepegboard holes of the second pegboard to maintain the leg positioner ina variety of desired positions.
 7. The modular patient positioningsystem of claim 1, wherein: the leg positioner including a boot, theboot having: a foot receiving portion receiving a foot of a leg whoseknee or hip is being operated on; a leg receiving portion receivinglower portion of a leg whose knee or hip is being operated on; and aplurality of pegs mounted to the boot and in a direction oblique to theaxes of the peg holes and for being received in the pegboard holes ofthe second pegboard to maintain the leg positioner in an orientation notparallel to the peg board.
 8. The modular patient positioning system ofclaim 1, wherein: the leg positioner including a boot, the boot having:a foot receiving portion receiving a foot of a leg whose knee or hip isbeing operated on; a leg receiving portion receiving lower portion of aleg whose knee or hip is being operated on; and a mounting blockattached to the foot receiving portion; and a positioner, the positionerhaving pegs for being received in the peg board holes, a rotatablesphere received in the positioner, a clamp for applying or releasing alocking grip on the sphere, and the sphere connected to the mountingblock, whereby the range of motion of the leg positioner is highlyadjustable.
 9. The modular patient positioning system of claim 5,further comprising: a mounting block connected to the foot receivingportion of the boot; and at least one first peg protruding from themounting block in a first direction and at least one second pegprotruding from the mounting block in a second direction; wherein thesecond direction is different from the first direction, wherebydetermination of the first or second pegs to be inserted into thepegboard holes determines the orientation of the leg positioned by theleg positioner.
 10. The modular patient positioning system of claim 9,wherein the protruding directions of the at least one first peg and theat least one second peg are perpendicular, thereby allowing the legpositioner to position a foot either perpendicular or parallel to thesecond pegboard.
 11. The modular patient positioning system of claim 9,wherein the protruding directions of the at least one first peg and theat least one second peg are oblique, thereby allowing the leg positionerto position a foot and rotate the leg at different angles relative tothe pegboard supporting the leg; wherein at least one of the angles isoblique to the supporting pegboard.
 12. The modular patient positioningsystem of claim 1, wherein: the leg positioner including a boot, theboot having: a foot receiving portion receiving a foot of a leg whoseknee or hip is being operated on; and a leg receiving portion receivinga lower portion of a leg whose knee or hip is being operated on; whereinthe mounting structure comprises a slidable block affixed to a portionof the boot and slidably mounted to the second pegboard for allowing theflexion/extension and/or distraction/compression of at least a portionof the leg to be varied, and the slidable block has a plurality ofpegboard holes defined thereon.
 13. The modular patient positioningsystem of claim 12, wherein the boot has pegs protruding therefrom andthe pegs are received in pegboard holes in the slidable block to affixthe boot to the slidable block.
 14. The modular patient positioningsystem of claim 12, wherein the boot is directly affixed to the slidableblock.
 15. The modular patient positioning system of claim 1, wherein:the mounting structure includes a pivot body having a generally upwardlyprotruding pivot peg; wherein the pivot peg is received in a pegboardhole defined in the second pegboard, whereby the second pegboard can bepivoted about the pivot peg.
 16. The modular patient positioning systemof claim 15, wherein a patient's acetabulum will be positioned generallyclose to the pegboard hole to receive to the pivot peg when the patientis positioned on the second pegboard.
 17. A modular patient positioningsystem, comprising: at least a first board and a second board, the firstboard and second board can be rotated relative to each other; wherein:at least the second board comprises a second pegboard, the secondpegboard having at least one pegboard hole defined in the secondpegboard; in a first configuration, the first board and second pegboardlie along a common plane; and in a second configuration, the first boardand second pegboard lie along different planes, whereby first and secondparts of a patient's body may be positioned and supported in differentplanes by having the first board support the patient's first bodyportion and the second pegboard supports the patient's second bodyportion, wherein the first body portion comprises an upper body portionand the second body portion comprises a leg receiving portion; and a legpositioner with a mounting structure for mounting the leg positioner onthe second pegboard and positioning a leg in a predetermined positionrelative to the second pegboard, the mounting structure of the legpositioner allows for adjusting at least one of axial rotation,abduction/adduction, elevation/depression, distraction/compression, orflexion/extension of the leg.
 18. The modular patient positioning systemof claim 17, wherein the first board comprises a first pegboard.
 19. Themodular patient positioning system of claim 17, wherein the first boardcomprises a surface of a surgical table.
 20. The modular patientpositioning system of claim 17, wherein: the mounting structure includesa pivot body having a generally upwardly protruding pivot peg; whereinthe pivot peg is received in a pegboard hole defined in the secondpegboard, whereby the second pegboard can be pivoted about the pivotpeg.
 21. The modular patient positioning system of claim 20, wherein apatient's acetabulum will be positioned generally close to the pegboardhole to receive to the pivot peg when the patient is positioned on thesecond pegboard.
 22. The modular patient positioning system of claim 20,wherein the angle of the pivot body relative to the first board changesas the system moves from the first configuration to the secondconfiguration.